S3172 Association of Low Vitamin D Levels With Failure to Respond to Helicobacter pylori Eradication Therapy: A Meta-Analysis

Introduction: Helicobacter pylori infection is a widespread chronic bacterial infection associated with peptic ulcer disease, gastric adenocarcinoma, and mucosa-associated lymphoid tissue lymphoma. Despite the efficacy of triple therapy, eradication failure remains a significant issue, often attributed to antibiotic resistance. Recent studies suggest that host immune status, particularly vitamin D levels, may play a pivotal role in treatment response. Vitamin D is known to modulate immune responses and induce antimicrobial peptides that may enhance bacterial clearance. This meta-analysis was conducted to evaluate the association between low serum vitamin D levels and the failure of H. pylori eradication therapy. Methods: A comprehensive literature search was conducted in PubMed, Semantic Scholar, and Google Scholar from January 2009 to May 2025. Observational studies, including cross-sectional and cohort designs, evaluating serum vitamin D levels in relation to H. pylori eradication outcomes were included. Of 57 initially identified studies, 4 met inclusion criteria with a total pooled sample of 75,188 patients (eradication group: 56,217; no eradication: 19,917). A random-effects model was used to estimate the pooled mean difference with 95% confidence intervals (CI). Heterogeneity was assessed using the I2 statistic, and publication bias was evaluated using a funnel plot. Results: The pooled analysis revealed that patients with successful H. pylori eradication had significantly higher mean serum vitamin D levels compared to those in whom eradication failed. The overall mean difference was 8.81 ng/mL (95% CI 1.11 to 16.52; P = 0.02), indicating a statistically significant association. Substantial heterogeneity was noted (Chi2 = 292.31; P < 0.00001; I2 = 99%; Tau2 = 60.79). The funnel plot was symmetrical, indicating no significant publication bias. Conclusion: Vitamin D deficiency is significantly associated with reduced success of H. pylori eradication therapy. These findings underscore the importance of considering vitamin D status in the clinical management of H. pylori infection. Further randomized controlled trials are warranted to evaluate the benefit of vitamin D supplementation as an adjunct to standard eradication therapy.